Americas expanding waistline is straining its knees--and
pocketbook--with hundreds of thousands of overweight people
undergoing surgery every year because the extra pounds they pack
are leading to tears in their meniscal cartilage.

In the first major study of its kind, University of Utah School
of Medicine researchers found the likelihood of tearing the
meniscus, the cartilage that bears much of the load on the knee
joint, increases dramatically with body mass index (BMI). (BMI is a
measure of body fat based on height and weight. People with a BMI
greater than 25 are considered overweight, and those with a BMI of
more than 30 are considered obese.)

Overweight people are at least three times more likely to tear
their meniscus, while the most obese men and women are 15 and 25
times, respectively, more likely to tear the cartilage, the U
researchers report in the May edition of the American Journal of
Preventive Medicine.

All the extra weight Americans are lugging around accounts for
up to 450,000 out of 850,000 operations for meniscus tears
annually, the researchers conclude. At an average of $3,000 per
operation, that adds a whopper of a bill to the nations medical
costs, according to Kurt T. Hegmann, M.D., M.P.H., research
associate professor of family and preventive medicine, who led the
study.

"Theres a potential savings of $1.3 billion in the costs
associated with meniscus tears in overweight and obese people,"
said Hegmann, director of the Us Rocky Mountain Center for
Occupational and Environmental Health.

Hegmann and his U colleagues studied 515 patients who underwent
meniscal surgery between 1996-2000 at LDS Hospital in Salt Lake
City and Utah Valley Regional Medical Center in Provo, Utah. These
patients were compared to a control group of 9,944 other Utahns
enrolled in the National Cancer Institutes Prostate, Lung,
Colorectal, and Ovarian Cancer Screening Trial during the same
years.

Participants were grouped into 10 BMI categories, ranging from
20 to greater than 40. The study participants also were grouped in
three age categories--50-59; 60-69; and 70-79.

The researchers calculated the Mantel-Haenszel ratio--an
age-adjusted odds ratio--for the likelihood of meniscal surgery and
found that men with a BMI of 27.5 and higher and women with a BMI
of 25 or higher were three times more likely to tear their
meniscus. Men whose BMI exceeded 40 were found to be 15 times more
likely to tear their meniscus; women in that BMI category were 25
times more likely to tear the meniscus.

"Since 57.4 percent (164 million people) of the U.S. adult
population is either overweight or obese, this relationship has
potentially large implications for meniscal surgeries," Hegmann and
his colleagues state in the article.

The prescription to correct the problem is not complex.

"A population-based weight management program could decrease
future burden on orthopedic and medical-care systems due to
meniscal surgeries and treatment of other obesity-related
conditions," the researchers state.

Other U researchers in the study include Gregory M. Ford,
M.S.P.H., U of U public health programs, George L. White
Jr., Ph.D., M.S.P.H., professor of family and preventive
medicine and public health programs director, and Edward B.
Holmes, M.D., M.P.H., assistant professor of family and
preventive medicine.